Community Transportation for Underserved Populations

Background

Government and community-based programs help meet the transportation needs of people who require specialized services. This includes people with disabilities, people with low incomes, and older adults. At the federal level, 130 programs may fund transportation services for these populations. Most of these programs fund limited transportation programs to get people to job training, health care, senior centers, or rehabilitation programs.

Program requirements differ widely. Most federal transportation funds are provided to states, local governments, and nonprofits through direct grants or block grants. Each federal funding program may require different reporting data and operate under a different funding cycle. Coordinating funding across local agencies is further complicated because the organizations themselves often use different billing systems. The public may also find it challenging to identify, understand, and use available services.

The best programs include coordination between public agencies and private and nonprofit providers at the state, regional, and local levels. This leads to better outcomes because the agencies can transport more people more efficiently. And riders can find rides more easily and conveniently. Coordinated programs are less likely to have vehicles sitting idle part of the day and are more likely to fill up all available seats. Among the opportunities for coordinating are joint vehicle purchase and use, vehicle maintenance, driver training, insurance, and dispatch program use. The most sophisticated level of coordination is when two or more human service transportation providers co-mingle their customers on one another’s vehicles. They can do so by interoperating their ride scheduling and dispatch software systems using a common transactional data format. These programs can reduce long-term costs but often require higher up-front costs.

Mobility management: This is an approach to managing and coordinating all the transportation resources in a community. This includes public and private transit operators, volunteer driving programs, walking, cycling, and other modes of transportation. Customers use a single point of access to coordinate multiple travel modes and providers.

Mobility management ensures that transportation options are convenient and best meet the needs in a particular community. It is especially useful for improving specialized transportation for older adults, people with disabilities, and people with low incomes. For example, the Kansas City Area Transportation Authority has created a single website with information about schedules, routes, and fares. All transit providers have adopted the same fare structure, allowing people to buy one pass and use it on different bus systems in the region. People with disabilities can get the same convenient on-demand service as others in the community and qualify for a reduced fare.

Programs to expand transportation options for older adults: Volunteer transportation services and ride-sharing are low-cost transportation options for older adults. Volunteer-provided transportation connects volunteers willing to provide rides with those needing rides. It is an essential resource for older adults and people with disabilities who may need help meeting their transportation needs. For example, they might use such services to go to medical appointments, the grocery store, and community events. Alternative transportation services, particularly volunteer programs, face ongoing challenges. These include recruiting volunteers, securing insurance, paying operational and administrative costs, and adhering to regulations from multiple funders. The federal nontaxable/deductibleThe amount that individuals must pay for services covered under an insurance plan before the insurer pays benefits. Not all out-of-pocket spending counts toward the deductible. reimbursement rate for charitable driving for 2021 is 14 cents per mile (compared with 56 cents for business-related driving). Reimbursement amounts above that rate are considered taxable income. (For information on insurance coverage on volunteer drivers, see Insurance Coverage for Volunteer Drivers).

Ride-sharing refers to carpooling and vanpooling. In these cases, a vehicle carries additional passengers when making a trip, with minimal additional mileage. Vanpooling generally uses rented vans (often supplied by employers, nonprofit organizations, or government agencies). Most vanpools are self-supporting, with members dividing operating costs.

Ride-sharing has minimal incremental costs because it makes use of vehicle seats that would otherwise be unoccupied. A computerized carpool matching service usually facilitates ride-sharing.

Nonemergency medical transportation (NEMT): NEMT connects people without access to transportation with their nonemergency, yet medically necessary, appointments. These could be such things as kidney dialysis and chemotherapy sessions. NEMT ensures that people not only have access to care but that they can receive that care. It can help ensure that people with no way to travel to and from medical appointments do so before a medical problem intensifies. NEMT providers maintain that such services save money in the long run and improve health outcomes.

The limited availability of nonemergency medical transportation and its high cost are significant concerns for many older adults, their healthcare providers, and insurers. Although Medicaid reimburses for NEMT, Medicare does only in some circumstances (see also Medicaid). Some nonprofit and human services agencies provide such transportation. But there is no targeted NEMT funding or program to meet the needs of older adults of all income and ability levels.

States may contract with brokers to manage NEMT services to expand access, improve quality, and contain the costs of such services. Brokers manage trip scheduling, provider oversight, and claims processing. They are selected through a competitive bidding process and must be cost-effective. Use of brokers can help states control costs and improve service quality.

Section 5310: The Federal Transit Administration (FTA) Section 5310 funding program provides capital assistance grants to buy buses and vans used to transport older adults and people with disabilities to places such as senior centers and congregate meal sites. Funding may also be used for mobility management.

Coordinated funding: In order to fully fund programs, effective state agencies coordinate financing from among federal programs. For example, many states use part of the funding from the Older Americans Act (OAA) to provide transportation services, often by transit operators under contract with the local area’s agency on aging. Typically, area agencies on aging use Section 5310 funding from the FTA to purchase vehicles. They then operate the vehicles in part with OAA funding, along with other federal, state, and local sources, including Medicaid and Head Start. The coordination of funding sources at all levels of government promotes the most efficient and effective use of transportation funds.

New private-sector funding opportunities: Recent federal policy changes have created new opportunities for transportation and healthcare sector collaboration. Effective January 2017, the Department of Health and Human Services has allowed medical providers across the U.S. to provide or facilitate medical transportation for their established patients. It was previously prohibited. In 2019, the Centers for Medicare & Medicaid Services (CMS) allowed Medicare AdvantageMedicare Advantage (MA) health plans are offered by private Medicare approved companies as an alternative to Original Medicare. Medicare pays these companies a fixed amount per enrollee per month to provide benefits for Parts A, B, and (usually) D. Plans to cover transportation to doctors’ offices (see also Medicare & Medicaid). In 2020, CMS allowed Medicare AdvantageMedicare Advantage (MA) health plans are offered by private Medicare approved companies as an alternative to Original Medicare. Medicare pays these companies a fixed amount per enrollee per month to provide benefits for Parts A, B, and (usually) D. Plans to pay for transportation for chronically ill patients to non-medical services, such as grocery shopping and banking. This has opened up new opportunities to address a critical social determinant of health for financially strapped people age 65 and older.

COMMUNITY TRANSPORTATION FOR UNDERSERVED POPULATIONS: Policy

COMMUNITY TRANSPORTATION FOR UNDERSERVED POPULATIONS: Policy

Coordinated community transportation programs

Policymakers and the private sector should establish coordinated public transit-human services transportation programs to meet the needs of underserved populations. These populations include older adults, people with limited mobility, and people with disabilities. They should also support the creation and maintenance of mobility management programs that help connect individuals to the most appropriate community transportation services (see also Universal Mobility as a Service).

Policymakers and the private sector should ensure a common transactional data format to enable efficient coordination of human services transportation.

In establishing and coordinating these programs, policymakers should consult with representatives from the local health care community, particularly those responsible for care coordination.

Local governments should provide publicly owned or publicly operated passenger vehicles for the transportation of older adults when such vehicles are not otherwise in use.

State and local governments should ensure coordination of all transportation programs and services that receive public funding.

All levels of government should foster coordination of transportation assets, eliminate duplicative services and other inefficiencies, and simplify consumers’ access to human services providers.

As part of implementing the Affordable Care Act, federal and state governments should explicitly designate transportation as an essential service for providing access to health care and for enabling older adults and people with disabilities to remain in their homes and communities.

Congress should ensure coordination of all federally funded transportation programs and services, including specialized transportation programs administered by the Federal Transit Administration (FTA) and those programs administered by the Department of Health and Human Services.

The federal government and states should encourage public-sector, nonprofit, and private-sector initiatives in joint vehicle purchase and use, shared vehicle maintenance, driver training, packaged insurance arrangements, and the development and support of dispatching programs that use geographic information systems. To do so, they should fund the initial start-up costs of these and other coordination efforts.

Technical assistance: The FTA should continue to provide technical support to state and local agencies for coordinating, carefully monitoring, and evaluating the implementation of state-administered plans for federally funded programs.

With the Administration for Community Living, the Department of Transportation should continue to help meet the transportation needs of those who do not drive by conducting or supporting research, acting as an information clearinghouse, and providing technical assistance to state and local transportation agencies.

Programs to expand transportation access for older adults

State and local governments should encourage ride-sharing, volunteer programs, and other low-cost programs to help meet older adults’ transportation needs (see also Insurance Coverage for Volunteer Drivers). This includes through public-private partnerships.

Congress should increase the charitable nontaxable reimbursement/deductibleThe amount that individuals must pay for services covered under an insurance plan before the insurer pays benefits. Not all out-of-pocket spending counts toward the deductible. rate for charitable driving to equal that for business-related driving. This would encourage individuals to participate in volunteer driver programs.

Medicaid nonemergency medical transportation (NEMT)

Policymakers at all levels should expand access to NEMT for people of varying income and ability levels. This includes exploring whether transportation brokerages can help expand access, reduce costs, and increase quality.

Policymakers should coordinate funding and provide sufficient budget to ensure adequate community transportation options to meet the needs of older adults and people with disabilities.

Section 5310: Congress should require the FTA to evaluate how well the Section 5310 program meets the needs of riders. Congress should fund the Section 5310 program at a level sufficient for providers to purchase replacement vehicles and expand services.